Dextrocardia and proper lead placement

Dextrocardia is a condition where the heart is located on the right side of the body, as opposed to the left. This condition is typically the result of a birth defect and doesn’t usually cause any problems. Patients with Dextrocardia are often undiagnosed until they receive their first chest x-ray or ECG. Depending on the person’s health history, they may go until early adulthood without knowing. Knowing that your patient has Dextrocardia will alleviate a lot of headache and confusion both in the pre-hospital setting and in the ER.

Below is an example of a chest x-ray of a patient diagnosed with Dextrocardia

When you encounter patient with Dextrocardia, it is important to place the ECG leads backwards. For example, the left-limb leads should be placed on the right side. If the leads are placed in their traditional location, the ECG will show inverted P and T waves.

Below is an ECG revealing Dextrocardia (The leads are in their traditional locations)

There is a lot documentation out there that suggests that defibrillator paddles / pads should be placed on the opposite side when defibrillating patients with Dextrocardia. However, there are also studies that show that paddle / pad placement doesn’t make much of a difference. If in doubt, contact your medical director and ask for guidance before being confronted with this situation.

Dextrocaria can be detected in a 12-lead ECG. An alerting sign is a P and QRS inversion in lead 1. If you encounter this, first check your limb leads to assess proper placement, then contact medical control to relay your findings. Do not assume that the patient has the defect if they have not been diagnosed by a physician.

Other than ECG placement and defibrillation, your treatment of patients with Dextrocardia doesn’t change.

If you have any questions, or have any more information, please comment below or e-mail me.

About The Author

Sean

I currently live and work as a paramedic in North Texas. I've been involved in EMS since the age of 18, and have essentially spent my entire adult life doing what I love. My passion is helping my fellow first-responders achieve successful and rewarding through healthy minds, bodies and wallets. I love talking to and meeting new people, so please don't hesitate to reach out and say hi!

Dextrocardia also known as Detroversion, Dextroposition or Dextrorotation is a state in which heart is situated on the right side of the body rather than the left. It could be since birth caused due to a disease or may be surgery.

And warning to all conscious patients please make sure the triage nurse on any visits to the ER knows to place correctly the leads.
I was admitted to ER and told the triage nurse about how usually if I don’t say anything the process has to be redone. The nurse insisted that she had been an ICU nurse fr 30 years and that the information I was giving her was incorrect.She did the EKG AND I was then taken to the attending Dr and sent for a chest XRay and the Dr came back in and said how sorry he was but some ‘event’ had happened and he had to admit me he asked the nurse to hook me up to oxygen and was prescribing whatever meds he felt I needed.I was distraught. What event coud ave happened.He said he didn’t know but my EKG was so different from one of a week before(I had been in hospital the week before for dehydration and before I left they did an EKG.It was perfectly normal. I suddenly mentioned how the triage nurse had put the leads on but insisted reversing leads was not necessary.He had an EKG redone and it was perfectly normal.He flew out to confront the triage nurse and was so upset about the situation as any of the meds could ave had a huge side effect ….so even when you tela nurse be sure if she doesn’t reverse the leads that you ask for a Dr – it is yor right.I know it is impossble if one is unconscious but otherwise insist.anjepanjie